The NHS missed its planning guidance target for 90 per cent of patients to be seen within four hours by September and recorded its worst second quarter performance against the standard since records began, official data reveals.

The September performance was worse than both the 89.7 per cent in August and 89.7 per cent in September 2017 – the previous low. NHS Providers has cited rising demand as the key driver. The planning guidance said the system should be back at the 95 per cent statutory standard during 2019.

NHSE also published combined data for the second quarter, between July and September, which revealed performance was the worst since records began in 2004-05.

Overall Q2 performance was 89.3 per cent, compared to 90.1 per cent in the same period last year, while type one was 83.4 per cent, down from 85.2 per cent in Q2 2017-18. In both cases, the 2017 performance was the worst until this year.

There was also further deterioration on the 18 week elective referral to treatment standard, which slumped to 87.2 per cent in August against the 92 per cent target. It was 89.4 per cent in August 2017.

NHS bosses in August set out urgent plans to address the elective waiting list deterioration, as exclusively revealed by HSJ, although the impact of this drive is not yet known.

NHS Providers deputy chief executive Saffron Cordery highlighted that the number of people admitted, transferred or discharged within four hours in emergency departments in September was up more than 3 per cent on the same period last year.

The demand figures, described by Ms Cordery as “steep and relentless”, said attendances were up 4.1 per cent in September against the same month in 2017, and emergency admissions rose 4.9 per cent, while type one admissions rose nearly 7 per cent.

She added: “[The figures] also highlight the frustrating paradox of trusts and frontline staff pulling out all the stops to cope with growing pressures, but slipping further and further from the constitutional standards the public have been told to expect, and the recovery trajectory set out in NHS planning guidance.”

Nuffield Trust research director John Appleby said the NHS faced its toughest ever winter, describing the 7 per cent rise in emergency admissions recorded in September as “astonishing”.

He said: “Despite great effort from staff across the country, the grim reality is that so far these figures trace the course to an even tougher winter for the NHS. Performance against the headline A&E target is already at the levels that just three years ago we were seeing in January, in the depths of winter.

“More people are waiting too long both in A&E itself and for emergency admission to hospital compared to last year. Planned care too is being squeezed: the proportion of people waiting more than the six week target for diagnostic tests is at its highest since records began.”

The Department of Health and Social Care has set up a “logistics hub” in Belgium and plans to manage its own dedicated shipping route from mainland Europe to the UK for vital medical products, as part of no-deal preparations, HSJ can reveal.